1. Particulars of License
(i) For an individual or incorporated
(a) Name :
(b) Address :
(c) Nature of Business :

(ii) For a firm
(a) Name : M/s.
(b) Business Address :
(c) Nature of business and the following particulars in respect of each person having any proprietory interest in the firm.
(i) Nature of Business :
(ii) Name :
(iii) Address :
(iv) Description :

2. Description of Goods to be imported:

3. Whether any goods other than:
those belonging to the
licensee for which he is an
agent are intended to be
warehoused.

4. Particulars of maximum stock intended to be held in the warehouse any one time.
(a) Name of package :
(b) Value :
(c) Duty (at rates in force at the time of application):

Note: In case of spirit intended for denaturation, this should be separately specified.

5. Particulars of maximum stock actually held at any one time under the expiring license (for use in case of renewals only)
(a) Date :
(b) No. of packages :
(c) Value :
(d) Duty :

6. Particulars of any change in :
proprietorship of the firm
since date of last renewal
(to be filed is only by
firms applying for renewals)

7. Particulars of premises to be licensed
(a) Name and address of owner:
(b) Place at which situated :
(c) Dimensions (in metres)
i) Length
ii) Breadth
iii) Height
(d) Distance from Customs House: Approx ________ Kms.
(Office of Assistant Collector, Mumbai)

NOTE: - If more than one godown is to be licenses, separate particulars should be given for each, if necessary, on a separate sheet.

8. Name and address of Banker:
or other persons to whom
reference may be made
regarding financial status of
the licensee.

I / We declare that the above particulars to be true and apply for grant / renewal of license under section 58 of the Customs Act, 1962 in accordance therewith.

Place : Mumbai

Date : Signature of Applicant(s)